Croakey

Tackling Indigenous incarceration: what’s the evidence?

July 3, 2009 – 12:00 pm, by Croakey

The Crikey piece by Chris Graham (ex the National Indigenous Times) on the criminally high incarceration rates of Aboriginal people has drawn some heated comment on the Crikey website.

This lead might be of interest to those wondering what policies have been shown to reduce incarceration rates.

In 2005, when legislators in Washington State were getting worried by predictions about the soaring costs of looking after increasing numbers of prisoners, they tried something novel. Rather shock-jock-based policy, they invested in research to identify useful evidence to guide their decisions.

They asked the Washington State Institute for Public Policy to conduct a systematic review of cost-effective, evidence-based options to reduce the projected future demand for prison beds, to save taxpayers money, and to contribute to lower crime rates.

The reviewers identified 560 controlled evaluations of adult corrections, juvenile corrections, and prevention programs and concluded that if “Washington can successfully implement a moderate-to-aggressive portfolio of evidence-based options, then a significant level of future prison construction can be avoided, state and local taxpayers can save about two billion dollars, and net crime rates can be lowered slightly.”

While it’s still early days, Washington is far less likely than many other places in the US to incarcerate its citizens.

I don’t know how relevant the review’s recommendations might be for reducing incarceration of Aboriginal people but it does seem at least worth looking at.

I wonder whether any Australian governments have commissioned such a review and, if so, what they’ve done about its findings?

I interviewed the director of the Washington State Institute for Public Policy, Roxanne Lieb, a few years ago and some of her general comments about the difficulty of having evidence-based interventions implemented may be relevant to this particular issue.

She said that evidence-based recommendations were not always politically welcome or timely and could meet resistance from interest groups.  “…decision making around funding is often driven by continuation of the status quo, the interests of constituents, and lobbying by service providers,” she says.

Which brings us back to Chris Graham’s piece. While we need to know what works, this isn’t enough. Political and public support (including prominent media coverage) is also needed.

You can read more about the Institute here and here.

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Liberally confused on smoking laws

July 2, 2009 – 3:36 pm, by Croakey

Last night, the former federal health minister Tony Abbott told a crowd at the University of Sydney that he didn’t support the NSW laws which took effect yesterday, banning smoking in cars carrying kids.

As a child, he was regularly imprisoned in a car with heavy smokers, he said. “Both my parents smoked heavily wherever they were.”

He drew a few laughs when he threw back his arms, displaying his trim physique, and asked theatrically whether his childhood exposure had done him any harm.

While Abbott said he hoped parents wouldn’t smoke in cars with kids, it was probably far from the worst that they could do to their children, and he wouldn’t be inclined to legislate against it. “Being hard hearted to your kids and not encouraging them to do their best are far more important crimes,” he said.

Abbott’s comments must have rung a few bells for his opponent in the debate about the Nanny State, Professor Mike Daube, who has subsequently dug up the 2006 press release below from Christopher Pyne.

Daube’s comment: “His health might not have been affected by passive smoking, but his memory seemed to have been….”

THE HON CHRISTOPHER PYNE MP
Parliamentary Secretary to the
Minister for Health and Ageing

28 November 2006 CP81/06

Support for ban on smoking in cars with kids

Smoking in a confined space such as a car is particularly harmful and it is important to limit the exposure of children to this danger, the Parliamentary Secretary to the Minister for Health and Ageing, Christopher Pyne, said today.

Mr Pyne said he supported Tasmanian Senator Guy Barnett’s proposal to ban smoking in vehicles carrying children.

“Tobacco smoke is a combination of poisonous gases and breathable particles that are harmful to health, particularly that of children,” he said.

“In confined spaces, such as cars, babies and children can be exposed through passive smoking to these poisons and harmful particles.

“Smoking in a car is particularly harmful. It is, therefore, very important to limit the exposure of children to this danger.

“Children exposed to passive smoking are more likely to experience such serious illnesses as pneumonia, middle ear infections and asthma attacks.

“Every week, on average, someone under the age of 15 dies from a tobacco-related cause.

“Someone dies from the effects of passive smoking every second or third day – that is, five people every fortnight.”

“The effects of passive smoking on babies, in particular, must not be underestimated,” Mr Pyne said. “I commend Senator Barnett for making his stand on this and for calling on the states and territories to act.

“I shall raise these issues with state and territory ministers at the Ministerial Council on Drug Strategy on 15 December.”

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Moving beyond the Nanny State debate in public health

July 2, 2009 – 11:17 am, by Croakey

The debate last night between public health advocate Professor Mike Daube and former health minister Tony Abbott - Welcome back nanny? Civil liberties vs the public good - was much tamer than I’d been anticipating.  I have written a piece about the Nanny State for today’s Crikey bulletin.

But here is an extract from Daube’s speech that I thought might be of interest to Croakey readers.

It is a section where he cites recent considerations by Sir Kenneth Calman and the Nuffield Council on Bioethics of issues around the relationship between the state’s authority and that of the individual, from the extremes of libertarianism to the collectivist views at the other end of the spectrum.

“They developed what they saw as a proposal to capture the best of the libertarian and paternalistic approaches which they described as ‘the stewardship model’.

This argues that liberal states have responsibilities to look after the important needs of people, both individually and collectively; therefore they are stewards to individual people, taking account of different needs arising from factors such as age, gender, ethnic background or socio-economic status, and to the population as a whole. In their view, the notion of stewardship gives expression to the obligation on states to seek to provide conditions that allow people to be healthy, especially in relation to reducing health inequalities.

What does this mean?

It means that public health programs should:

*    Aim to reduce the risks of ill health that people might impose on each other

*    Aim to reduce causes of ill health by regulations that ensure environmental conditions that sustain good health – from clean air and water and safe food onwards

*    Promote health not only by providing information and advice but also to prevent and assist people deal with unhealthy behaviours

*    Seek to ensure that it is easy to lead a healthy life

*    Recognize that for many of them there is currently no real choice about how they can live healthily or avoid misinformation.

*    Ensure appropriate access to medical services

*    And pay particular attention to protecting the health of children and vulnerable groups and reducing inequalities.

In that context, we should recognize that we:

*    Cannot coerce adults other than where there is a clear cause (such as drink-driving)

*    Should minimise interventions that are introduced without the consent of those affected or without procedural justice, and

*    Should seek to minimise interventions that are perceived as unduly intrusive and in conflict with personal values.

If those principles are broadly accepted, there is then an intervention ladder, starting with doing nothing or monitoring, moving through approaches such as providing information or enabling and offering choices, moving on to restricting choice – for example through removing unhealthy ingredients from foods, as Mayor Bloomberg has done with transfats in New York, and finally moving through to the hardest forms of action - constraint, as with eliminating tobacco advertising, or elimination of any choice – such as compulsory isolation of patients with infectious diseases.

Stewardship also recognizes that it is often the role of the State to make choice a genuine option.

The concept of stewardship recognizes the need to act carefully and deliberately, but also places the onus fairly and squarely on decision-makers to act in the public interest – at times to move to those hard forms of action - and to recognize the consequences if they fail to act.”

Presumably Daube is hoping that the stewardship model might supplant the more simplistic debate that we so often hear around the Nanny State.

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More unreleased health documents

July 1, 2009 – 2:11 pm, by Croakey

We have a new entry for the Croakey Register of Unreleased Documents.

As well, the Nutbeam review of public health research funding has been officially liberated from the Register as it was released, at last, in June.

CRUD records the details of evaluations, plans, reviews and other such documents that should be released (whether by governments or other commissioning bodies), in the interests of promoting better informed policy, practice and debate.

The new entry is:

• The Government undertook a Strategic Review of Future Funding Arrangements for Diagnostic Imaging and Pathology Services to consider options for the future funding of these, including the impact of those arrangements on Government expenditure and the availability and affordability for patients of diagnostic imaging and pathology services.

The DoHA website states that ‘It is expected that the review will be considered by the Government in the lead up to the 2009-10 Budget’.
There are considerable changes made to the funding of  pathology and diagnostic imaging services in the Budget (spending of $982.0 million / 4 years with offsetting savings of $922.7 million) but the review itself does not seem to be publicly available.

If anyone can provide Croakey with a copy of the review, we would be most grateful.

Other CRUD entries:

• A Hospital Information and Performance Program Review and a National Hospital Cost Data Collection Review. According to the Department of Health and Ageing’s annual report, these have been completed and their recommendations are informing improvements in information about the hospital services and costs associated with those services, and in particular improving information on trends in hospital utilisation. The 2009-10 Health Budget provides $39.6 million over 4 years to continue funding for the Hospital Information and Performance Information Program, now renamed the Hospital Accountability and Performance Program. The Budget papers acknowledge the increasing importance of this work in the Government’s commitment to develop comparable performance measures across the public and private sectors and to move to activity-based hospital funding. However these two reviews do not seem to be publicly available.

• A review of the Rural and Remote General Practice Program. This was conducted in 2005 and is thought to have informed recent changes announced in the Budget but has not been released.

• A Report on Incentives and the Australian Health Workforce  - Completed by the Australian Health Workforce Institute in April 2009 but marked “not for public release”.

• Two reviews of the Rural, Remote and Metropolitian Areas (RRMA) classification system have been undertaken
The most recent one was done in conjunction with the review of “targeted rural health programs” that was behind various changes in the Budget, including the move from RRMA to the ABS’s Australian Standard Geographical Classification (ASGC) system. An earlier review of RRMA was apparently also undertaken some years ago, under Minister Abbott’s reign. So far as Croakey knows, neither review has been publicly released.

• The NSW Radiotherapy Plan  2006-2011
Our source says NSW Health has failed to release this document despite a number of requests (not to mention the fact that we are already three years into the period of the plan).

• Evaluation of the National Suicide Prevention Strategy – Final Report
Prepared for Department of Health and Ageing by Urbis Keys Young
The evaluation is dated April 2006.
(Please contact Croakey if you’d like a copy)

• Summative Evaluation of the National Mental Health Plan 2003-2008
The evaluation is by US consultant Charles Curie and English psychiatrist Professor Graham Thornicroft
(Please contact Croakey if you’d like a copy)

• A national evaluation of the Primary Health Care Research Evaluation & Development program
Our Croakey informant says: “This is a major Department of of Health and Ageing initiative that has substantially increased the national capacity for and actual implementation of PHC research. This has been through capacity building funding to departments of rural health and general practice, direct research grants, research fellowships and the Australian Primary Health Care Research Institute. This is an important program. For example, some of the resultant work and key researchers involved in these activities have contributed directly to informing the current policy reform debate through the NHHRC & Preventative Health Taskforce.”

• Growing the evidence base for early intervention for young children with social, emotional and/or behavioural problems: systematic literature review
Commissioned by the Victorian Department of Human Services. Dated April 2008.
Authors: Melissa Wake, Harriet Hiscock, Jordana Bayer, Megan Mathers, Tim Moore, Frank Oberklaid

• The National E-Health Strategy, developed for AHMC/AHMAC, managed by the Department of Human Services in Victoria

Our informant says this has yet to be released although a brief summary was slipped out quietly on December 22, 2008.

Here’s what the DoHA website says about this strategy which, if it is such a “useful guide to the further development of E-Health in Australia”, and is to help the States and Territories and the public and private sectors “determine how they go about E-Health implementation…”,  ought to be publicly available.

“The National E-Health Strategy developed by Deloitte, together with key stakeholders, provides a useful guide to the further development of E-Health in Australia. It adopts an incremental and staged approach to developing E-Health capabilities to:

• leverage what currently exists in the Australian E-Health landscape;

• manage the underlying variation in capacity across the health sector and States and Territories; and

• allow scope for change as lessons are learned and technology is developed further.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia. It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.

• A review of the Medical Specialist Outreach Assistance Program

It was commissioned by DOHA back in 2004 but has never been made public despite a number of organisations asking for copies.

If you know of evaluations, reviews and other such documents that should be on the public record, please drop us a line.

Documents liberated from the CRUD:

•  The Nutbeam review of public health research funding. Commissioned by the NHMRC in 2008, released (after some delays and much frustration on the part of Don Nutbeam and others) in June 2009

• Evaluation of the University Departments of Rural Health Program and the Rural Clinical Schools Program. Available here.

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Tony Abbott Vs Public Health

July 1, 2009 – 12:47 pm, by Croakey

Tony Abbott was not known, during his time as health minister, for seeing eye-to-eye with public health advocates. Tonight he takes to the stage at the University of Sydney to debate leading public health advocate Professor Mike Daube.

Their subject: Welcome back nanny? Civil liberties vs the public good.

The timing is perfect (and not only because of Liberal leadership jockeying) but because of the anticipation surrounding the recommendations of the Preventative Health Taskforce.

The debate will be chaired by Crikey and Croakey correspondent, Prof Simon Chapman.

At the Eastern Ave Lecture Theatre, University of  Sydney, from 6pm.

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Public health brigade urged to stand up and be counted

June 30, 2009 – 1:51 pm, by Croakey

After keeping us waiting for some time, the NHMRC has finally delivered a swag of reviews and reports for public comment, including the much-anticipated Nutbeam Review of Public Health Research Funding (which has been the subject of some interest previously at Crikey and Croakey).

The NHMRC is seeking comment on its strategic plan,  and has also released a review conducted in October 2007 and chaired by Professor Alan Bernstein, the then President of the Canadian Institutes of Health Research, as well as a review conducted in January 2008 and chaired by Dr Elias Zerhouni, Director of the United States National Institutes of Health (both available here).

In the article below, Professor Glenn Salkeld, head of the School of Public Health at the University of Sydney, gives an overview of the Nutbeam review and urges colleagues to “get active”:

“We should all get behind the recommendations of Nutbeam Report of the Review of Public Health Research Funding in Australia. If I had to pick one sentence that captures the spirit of the report it is this:

“High quality public health research that leads to improved health outcomes is most likely to emerge from a thriving public health research community conducting a combination of investigator driven and strategic research.”

This report is all about what it will take to truly deliver the promise that public health research will improve population health. Yes, it will take additional investment by NHMRC in public health research but the message here is not simply to ‘splash the cash’. Rather, a far more strategic and crafted approach to how the investment is made and how it links to policy and practice is required.

The Report contains 14 recommendations that call on NHMRC to take a greater role in leadership in public health research and in improving the processes and coordination of research, policy and practice in Australia.

The report delivers the recommendations in 3 sections: strategic leadership and co-ordination (aligning to the Government’s preventative health strategy), changes to funding strategies and mechanisms and improvement’s to NHMRC application and assessment processes.

The sentiments behind the recommendations are forward thinking and collaborative. Strategic thinking, priority driven research, innovation, flexibility and responsiveness, transparency, infrastructure and workforce capacity building are needed.

The Report calls for NHMRC to move beyond descriptive research and fund more intervention research.

There is a separate and comprehensive set of recommendations relating to Indigenous Public Health Research. Again the call is to move beyond further descriptive studies and focus on intervention research and on rigorous evaluation of interventions in priority research areas.

The deployment of these ideas and improvements will take strong leadership and political commitment by NHMRC. We are not off to a good start.

Recommendation 3 calls on DoHA to further develop the Public Health Education and Research Program (PHERP) to support national Centres of Excellence in key public health priority areas. So what does DoHA do? Abolish PHERP.

PHERP has delivered generalist public health education to the masses but we need to move on and develop specialist training and workforce capacity building.

As the Nutbeam Report observes, we have spread our public health research talent too thin in the application of PHERP funds. What we need is a smaller number of world-class groupings in Australia.

The recent call for NHMRC Centres of Research Excellence in Public Health and Health Services Research are an important step towards that objective.

Imagine what could be achieved if that was matched with a DoHA initiative to fund a national Public Health Office Training Program that took our best and brightest MPH graduates and delivered specialty training ‘in the field’.

While we’re at it, what are we doing to support the next generation of health policy makers?

Then there is the all important track record in public health research funding. In the last decade the NHMRC research funding pie has grown substantially yet the success rate for Public Health for project grants, research fellowship and program grants has been poor. There is a dearth of NHMRC Senior Research Fellows in Public Health.

Many countries have faced the same problems, how to build public health workforce capacity, focus on strategic research (whilst maintaining important investigator driven research) and how best to transfer results into policy and practice. Canada leads the way with the establishment of a Public Health Research Canada Strategic Plan which includes start-up funding grants, rapid response intervention program, infrastructure grants and support for 14 Chairs at mid-career (Associate Professor) level. All great ideas – good enough to borrow for ourselves.

For a relatively modest investment in money, infrastructure and improved processes NHMRC has an opportunity reap great rewards from their investment in Public Health.

We have a unique opportunity with the Government’s commitment to preventative health to do just that. Write to Warwick Anderson, the CEO of NHRMC, and tell him you back the Nutbeam Report recommendations. The sooner the better.”

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Why Roxon needs to move beyond talking about hospital waiting lists

June 30, 2009 – 1:01 pm, by Croakey

The State of our Public Hospitals report released today is the second such document released under Minister Roxon’s reign.

The report, whose publication is required under the Australian Health Care Agreements, inevitably leads to media reports comparing and contrasting the performance of the various states and territories, especially around elective surgery waiting  times.

In the piece below, health policy analyst Jennifer Doggett argues that Minister Roxon needs to refocus the public debate on more important issues:

” If you’re wondering why the Government’s $600 million funding boost for public hospitals failed to reduce elective surgery waiting times. a trip to the local supermarket will help explain this.

When announcing the plan prior to Labor’s 2007 election, the (then) Shadow Minister for Health, Nicola Roxon said “our $600 million elective surgery plan will reduce waiting times, state by state and hospital by hospital”.

However, the State of our Public Hospitals report – which should be available here sometime today – shows that the average waiting time for treatment has increased from 32 days in 2006-07 to 34 days in 2007-08. Almost a third of people presenting to emergency departments were not seen within the recommended time, an increase on the previous year.

Given that the government’s additional funding enabled hospitals to treat more patients, why did waiting times increase?

The reason lies in a basic economic principle – that as the price of most goods and services drops, the demand for them will increase.

Of course public hospital services are free to consumers at the point of service, but it would be a mistake to think that this means that they cost nothing.  As Adam Smith famously wrote, “The real price of everything, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.”

One of the costs of public hospital treatment to patients is the time spent waiting for treatment.   So if consumers believe that waiting times – and therefore the cost - of public hospital services will decrease, their demand for these services will increase.

This will result in an increase in waiting lists, despite the fact that more services are being provided.

A similar effect can be observed in supermarket queues. The reason that supermarket queues are all about the same length is that people will adjust their behaviour to minimise waiting times.  If one queue suddenly gets shorter, people will quickly move from a longer queue to even up the difference.

If a supermarket decided to increase the output at one checkout – for example by putting in another operator so two people could be served at once – this queue would not be half as long as the others.

As customers became aware that one queue was moving more quickly than the others, enough of them would move to ensure that the waiting times at all check-outs were about the same.

A similar effect has occurred in the public hospital system.  As hospitals have increased the numbers of elective procedures they perform, demand for their services has risen.

This increase is likely to have come from at least three sources:

•    a shift from the private sector as people re-evaluate whether or not it is worth paying the additional cost of private hospital treatment to avoid waiting times (even with private health insurance this can often involve substantial co-payments);

•    a re-evaluation of treatment options from people who have the choice of or an alternative treatment for their condition – such as someone with a sports injury who has the option of surgery or an extended course of physiotherapy; and

•    a return to waiting lists from people who had ‘given up’ seeking treatment due to the long waiting times.

Of course, the fact that more people have received public hospital treatment is a good outcome.  Despite the media and political focus on waiting times and waiting lists, they are not good measures of hospital performance when looked at in isolation.

A reduction in waiting list numbers simply measures the increase in output of a hospital relative to its increase in demand.  By this criterion, a hospital which is not popular with consumers would score better than one with a higher demand for its services (even if they have both increased their output by the same degree).

Better outcome measures are the overall increase in numbers of patients receiving treatment and their level of clinical need.

If the Government wants to claim its $600 million funding boost as a success, it needs to stop talking about waiting list reductions and start focussing on the outcomes that really matter.”

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Believe it or not: journalists do care about bent stats

June 29, 2009 – 6:50 pm, by Croakey

In an unusual collaboration, journalists, academics and politicians in England have joined forces in an offensive against bent stats.

Straight Statistics, according to its website, aims to:

  • Draw attention to the inaccurate reporting of statistics in the media, and encourage better standards by training and example.
  • Ensure that Governments follow the Code of Practice on the use of official statistics and the guidance issued by Sir Gus O’Donnell in February 2009.
  • Monitor the use by local government, advertisers and industry of claims based on statistical or numerical information.
  • Examine the statistical basis of claims made in scientific and medical journals, in the interests of greater clarity and sounder reasoning.

Straight Statistics, which was launched just a few weeks ago, has been set up with a Grant for Research and Innovation from the Nuffield Foundation.

What’s  particularly interesting is the group behind the campaign.

The board of directors include:

  • Lord Lipsey (Chairman)
  • Nigel Hawkes, freelance journalist  (Director)
  • Professor Sheila Bird, MRC Biostatistics Unit, Cambridge
  • Simon Briscoe, Statistics Editor, Financial Times
  • Dr Ben Goldacre, Guardian columnist and author of Bad Science
  • Dr Helen Joyce, Britain Correspondent and International Education Editor, The Economist
  • Martin Moore, Director, Media Standards Trust
  • Professor David Spiegelhalter, Winton Professor of the Public Understanding of Risk, University of Cambridge.

Nigel Hawkes, the organisation’s director, was quoted in a British Medical Journal news story saying that the initiative “grew out of a conviction that statistics are often misused and that public confidence in them is low.”

“The worst abuses appear to be in government departments,” he told the BMJ. “The same figures are used by one group and ignored by others.”

Mr Hawkes, a freelance journalist who writes for the BMJ, Times, and Sunday Times, previously believed the worst offenders to be newspapers but has since found that there is “not a huge amount of evidence” for statistical misuse by journalists.

Who says that journalists don’t care about truth-in-publishing…

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What will it take for doctors to reject pharma largesse?

June 29, 2009 – 6:20 pm, by Croakey

When the NHMRC convened a workshop on conflicts of interest in Canberra recently, participants were told that Australia had been slower than some other countries to take steps to minimise the impact of such conflicts upon research and clinical practice.

In the piece below, Sydney dermatologist Dr Chris Commens argues that unless the medical profession smartens up its act, it may face the sort of legislative action that has already occurred overseas:

“Quite frankly I find it insulting to suggest I would be influenced by being given a pen or a mug.”

“So what if the drug rep brings pizzas for lunch for the staff!”

These are the sort of comments you often hear from doctors and others who are resistant to the evidence that pharmaceutical marketing can influence patient care.

While the level of debate swings around this trivialisation, the pharmaceutical companies are laughing their way to the bank. The average punter in the street hardly registers this sort of junketeering as a problem.

However, some medical practitioners who prescribe extremely expensive drugs are being given free travel, meals and accommodation to attend interstate drug familiarisation conferences.

After all, spending approximately $2000 over a weekend on a doctor is quickly returned with increased prescribing of  drugs costing tens of thousands per course.

The possibility of this sort of hospitality consciously or unconsciously swaying prescribing habits has credibility. Reciprocity (repaying a favour or hospitality) is a strong social, cultural and possibly biological response, particularly in highly socialised creatures like  doctors.

It’s something the drug companies use to the hilt – and something a lot of doctors deny to the hilt.

So how is this issue of drug company influence being addressed?

State Medical Boards have markedly differing emphasis with their Codes of Conduct. NSW directs doctors not to accept material gifts. “Material” is undefined. State Health departments have rules for employees but these are variably administered.

The variations in state codes has  recently seen the Australian Medical Council attempt a uniform Code of Ethics for doctors across Australia. The
first AMC draft addressed the issue of drug company sponsorship bluntly by prohibiting all gifts, inducements or hospitality.

A hullaballoo followed.

The subsequent draft is a more subdued document. Conflict of Interest is discussed and we are now advised to “not accept any inducement, gift or hospitality of more than trivial value that may affect, or be seen to affect the way you prescribe or treat”.

I predict little will change until it is put in law.

And this is precisely what is happening in a number of  USA States.

The legislators in Vermont have recognised that hospitality is a marketting tool that tends to encourage the use of expensive therapies over
evidence-based cheaper therapies. Importantly since 2002 they have required drug companies to publish on a public website the names of all individual recipients of all gifts and payments.

Overall , since instituting this publication of named recipients. they have documented decreased pharmaceutical spending on hospitality to doctors
although one individual doctor in 2008 racked up US$15000 in free meals.

As a result the Vermont legislators  will now PROHIBIT  most hospitality to doctors from July 1, 2009.

The AMC code of Conduct is a start but unless we doctors smarten up, the legislators will move.

CROAKEY comments: It’s worth checking out the Vermont link as it details some of the pharma payments to nurses and doctors (one psychiatrist received more than $US100,000).

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Israeli president of the World Medical Association comes under fire

June 29, 2009 – 4:28 pm, by Croakey

More than 700 doctors from around the world have called for the Israeli president of the World Medical Association to step down, calling him “unfit for office” and claiming that he has turned a blind eye to the “institutionalised involvement of doctors” in torture in Israel, according to a news report in the latest British Medical Journal (the abstract is freely available here but you have to pay to see the whole report if not a subscriber).

The doctors say that the appointment of Yoram Blachar, president of the Israeli Medical Association since 1995, as president of the World Medical Association last November is “a matter of grave concern”.

They say it “makes a mockery of the principles on which the WMA was founded in 1947, which was a response to egregious abuses by Germany and Japan in World War Two.”

In a letter, the doctors list numerous reports highlighting the use of torture by doctors in Israel and occasions when the Israeli Medical Association has failed to respond to the charges.

In 1996 a report from Amnesty International concluded that Israeli doctors working with security services “formed part of a system in which detainees are tortured, ill treated, and humiliated in ways that place prison medical practice in conflict with medical ethics.”

At the time Dr Blachar “took no action,” says the letter. It adds that Dr Blachar had justified, in a letter to the Lancet in 1997, the use in Israel of “moderate physical pressure”.

However, a World Medical Association spokesman said that this statement was not Dr Blachar’s opinion but a reference to Israeli guidelines and that it has been widely misquoted. The spokesman said: “Dr Blachar did not then endorse the use of torture and has not done so since. Indeed he has repeatedly supported WMA policy statements and documents that condemn all use of torture, whether by physicians or others.”

The British Medical Association said: “On the basis of imperfect and contested information, although Dr Blachar’s position as joint president of the World Medical Association and the Israeli Medical Association is a difficult one, in our view he has made authoritative statements, as president of both organisations, calling on the Israeli Defense Forces (IDF) and any doctors operating under the IDF’s remit to respect international ethical standards.”

Dr Blachar did not respond to a BMJ request for comment. In previous correspondence in the BMJ, he has several times denounced the use of torture by Israeli doctors.

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